摘要
目的 构建和验证预测老年重症肺炎机械通气患者脱机失败的风险的列线图.方法 回顾性分析2021年7月-2023年7月于我院住院治疗的老年重症肺炎机械通气患者330例临床资料,根据患者脱机结局分为脱机成功组(n=213)和脱机失败组(n=117).采取单因素分析和多因素非条件Logistic回归分析探究影响老年重症肺炎机械通气患者脱机失败的因素,基于此回归结果构建并验证列线图.结果 单因素分析显示,两组患者年龄、吸烟、合并慢性阻塞性肺疾病、通气时间、白蛋白、D-二聚体及氧合指数水平差异有统计学意义(均P＜0.05).多因素Logistic回归分析显示,年龄≥65岁、吸烟、合并慢性阻塞性肺疾病、通气时间≥7 d、D-二聚体≥2 000 μg/L及氧合指数降低是老年重症肺炎患者脱机失败的危险因素.由此构建的列线图模型受试者操作特征曲线下面积为0.970(95％置信区间0.952～0.989),校准曲线显示预测结果与观测值之间具有较好的一致性.结论 年龄、吸烟、慢性阻塞性肺疾病、通气时间、D-二聚体、氧合指数是老年重症肺炎机械通气患者脱机失败的影响因素,由此构建的列线图模型具有良好的区分度和准确性.
Abstract
Objective To develop and validate a nomogram for predicting the risk of weaning failure inelderly patients with severe pneumonia undergoing mechanical ventilation.Methods A retrospective analysis was conducted on the clinical data of 330 elderly patients with severe pneumonia undergoing mechanical ventilation who were hospitalized in our hospital from July 2021 to July 2023.According to their weaning outcomes,they were divided into a successful group(n=213)and a failure group(n=117).Univariate analysis and multivariate non-conditional logistic regression analysis were used to explore the factors influencing the weaning failure of mechanical ventilation in elderly patients with severe pneumonia.Results Univariate analysis showed that there were significant differences in age,smoking status,chronic obstructive pulmonary disease,ventilation time,albumin,D-dimer,and oxygenation index levels between the two groups(all P＜0.05).Multivariate logistic regression analysis revealed that age ≥65 years,smoking,presence of chronic obstructive pulmonary disease,ventilation time ≥7 days,D-dimer ≥2 000 µg/L,and reduced oxygenation index were risk factors for weaning failure in the elderly patients with severe pneumonia.The nomogram model constructed based on these factors had an area under ROC curve of 0.970(95％CI 0.952-0.989),and the calibration curve demonstrated good agreement between predicted and observed values.Conclusions Age,smoking status,chronic obstructive pulmonary disease,ventilation time,D-dimer,and oxygenation index are influencing factors for weaning failure in elderly patients with severe pneumonia receiving mechanical ventilation.The nomogram model constructed based on these factors exhibits good discrimination and accuracy.
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